1. PHYSIOLOGY OF POLYCYSTIC OVARY
SYNDROME: ITS CLINICAL AND
NUTRITIONAL INTERVENTIONS
POULAMI DASGUPTA
MSc.FOOD AND
NUTRITION
PREVIOUS

2. PCOD vs. PCOS
WHAT IS PCOD?
•This disease exists where there is an imbalance of
hormones which cause cysts to develop
•There is a gathering of developing or mature eggs, which are
inside the ovary, but for some reason, cannot be released
•This cycle continues every month and finally results in quite a few
health issues for women
•A number of incidents can trigger a shift in the normal flow of
hormones such as stress, poor diets, and including too much or not
enough insulin
•The symptoms involve irregular periods, hair loss, temporary
infertility, or fat collection in the abdominal area
•The simplest treatment is hormone medication

3. WHAT IS PCOS?
Also known as STEIN-LEVENTHAL SYNDROME (in the
name of U.S.gynaecologist I.F.Stein and Obstetrician
M.L.Leventhal) (Taber’s Medical Dictionary,20th Edition)
Hormone inconsistencies results in no release of ovum
The ovaries starts to produce high levels of testosterones,
causing the hormones to cause imbalance
Increase in weight, irregular cycles, loss of hair, difficulty
conceiving, and skin irritation
Of the two diseases, PCOS is the most serious, although both
conditions can be treated with pills and intravenous medication
COMPARISON
Both conditions are contributors of unstable hormones,
irregular cycles, loss of hair, weight gain, and some form of
infertility. However, these symptoms will not show up in
women until they are well into their twenties

4.  Excessive ovarian stimulation caused by the
progressively rising insulin and insulin like
growth factor - I (IGF-I) levels during
puberty induces a PCOS in predisposed girls
(Nobel's and Devailly Fertil Steril 1992)
 5-alfa reductase activity is stimulated by
iGF-I. This intensifies the hirsute response
in hyper androgenic patients
(Speroff 1993)

6. CAUSES
•The cause of PCOS is unknown, although some
evidence suggests that patients have a functional
abnormality of CYTOCHROME P450 C17 which
is the rate-limiting enzyme in androgen biosynthesis
•CYTOCHROME P450C17 is active in the
adrenals and ovaries, and excess activity of this
enzyme could explain the increased androgen
production

10. DEFINITE
 Type 2 diabetes
 Dyslipidemia (Hypercholesterolemia with
diminished HDL2 and increased LDL)
 Endometrial cancer

11. POSSIBLE
 Hypertension
 Cardiovascular disease
 Gestational diabetes mellitus
 Pregnancy-induced hypertension
 Ovarian cancer
UNLIKELY
 Breast cancer

12. TESTS FOR DETECTING PCOS
•An enlarged clitoris (very rare finding) and enlarged
ovaries
•Diabetes, high blood pressure, and high cholesterol are
common findings, as are weight gain and obesity
•Increased Weight & BMI, and abdominal circumference are
helpful in determining risk factors
Levels of different hormones that may be tested
include:
•Estrogen levels
•FSH levels
•LH levels
•Male hormone (testosterone) levels
•17-ketosteroids

13. Other blood tests that may be done include:
•Fasting glucose and other tests for glucose
intolerance and insulin resistance
•Lipid levels
•Pregnancy test (serum HCG)
•Prolactin levels
•Thyroid function tests
Other tests may include:
•Vaginal ultrasound to look at the ovaries
•Pelvic laparoscopy to look more closely at, and
possibly biopsy the ovaries

14. SYMPTOMS
CHANGES IN THE MENSTRUAL CYCLE
•Absent periods, usually with a history of having one or more normal
menstrual periods during puberty (secondary amenorrhea)
•Irregular menstrual periods, which may be more or less frequent, and
may range from very light to very heavy
•Development of male sex characteristics (Virilization)
•Decreased breast size
•Deepening of the voice
•Enlargement of the clitoris
•Increased body hair on the chest, abdomen, and face, as well as
around the nipples (called hirsute)
•Thinning of the hair on the head, called male-pattern baldness
OTHER SKIN CHANGES
•Acne that gets worse
•Dark or thick skin markings and creases around the armpits, groin,
neck, and breasts due to insulin sensitivity

16. ACNE
VULGARIS AND
HIRUTISM

17. ANXIETY, MOOD DISORDERS IN ALL WOMEN WITH
PCOS
•Low self-esteem, poor body image, and fears about future health
problems, including infertility, and perceived lack of effective
treatment, all of which may make them anxious (Dr. Dokras et.al.
November 29 , online report in Fertility and Sterility)
•Two of three studies reported a higher prevalence of social phobia
in women with PCOS and
•one of two studies reported a higher prevalence of obsessive
compulsive disorder (OCD)
However studies say more research is needed to clearly define the
prevalence of anxiety disorders in adolescents with PCOS

18. ENDOCRINE ABNORMALITIES
GONADOTROPINS
Elevated mean serum concentrations of LH
ANDROGENS
Elevated Serum concentrations of testosterone and androstenedione
ESTROGENS
Serum concentrations of estradiol (both total and free) lie within the normal
ranges for the early follicular and mid-follicular phases of the cycle
PROLACTIN AND GROWTH HORMONE
Less common hyperprolactinemia and impaired secretion of growth hormone.
The prevalence has been reported to be between 5 and 30 percent
METABOLIC ABNORMALITIES
Characterized by extreme insulin resistance associated with ovarian
hyperandrogenism.

20. INSULIN
RESISTANCE

21. TREATMENT
•Losing weight (which can be difficult) has been shown to help
with diabetes, high blood pressure, and high cholesterol. Even a
weight loss of 5% of total body weight has been shown to help
with the imbalance of hormones and also with infertility
Medications used to treat the abnormal hormones and
menstrual cycles of polycystic ovary syndrome include:
•Birth control pills or progesterone pills, to help make menstrual
cycles more regular

22. METFORMIN : can improve the symptoms of PCOS
and sometimes will cause the menstrual cycles to
normalize
•also makes cells more sensitive to insulin, and may
help make ovulation and menstrual cycles more
regular, prevent type 2 diabetes, and add to weight loss
when a diet is followed
•Use of LH-releasing hormone (LHRH) analogs
•Anti-androgen medications, unwanted hair removal
using laser-non laser light sources, treatment with
MYO (L-Myo-Inositol-1-Phosphate), PELVIC
LAPAROSCOPY to treat anovulation and infertility
are some of the treatments for PCOS

23. NUTRITIONAL
INTERVENTIONS
IN PCOS:
MACRONUTRIENTS,
MICRONUTRIENTS
AND
HERBS

24. DIET
•Patients with polycystic ovarian syndrome (PCOS) who have
impaired glucose tolerance should have a comprehensive
program of diet and exercise to reduce their risk of developing
diabetes mellitus
•In addition, obese women with PCOS can benefit from a low-
calorie diet for weight reduction
•A diet patterned after the type 2 diabetes diets have been
recommended for PCOS patients
•Increased fiber; decreased refined carbohydrates (LOW GI
FOODS), Tran’s fats, and saturated fats; increased omega-3 and
omega-9 fatty acids
•However, others have shown that in obese patients with PCOS,
weight loss improves menstrual regularity; the type of diet used
did not matter

27. •Omega-3 fatty acid supplementation has been
shown to reduce liver fat content and other
cardiovascular risk factors in women with
PCOS, including those with hepatic steatosis,
although these effects have not yet been proven
to translate into a reduction in cardio metabolic
events
•Women with abnormal lipid profile need to be
counseled on ways to manage the dyslipidemia.
Such measures include eating a diet low in
cholesterol and saturated fats and increasing
physical activity

28. MULTIVITAMIN AND MINERAL
VITAMIN D
Evidence suggests that vitamin D deficiency may contribute to
the development of the metabolic syndrome, and one study
found insufficient levels of 25-hydroxyvitamin D (< 30 ng/ml)
in almost three quarters of PCOS patients, with lower levels in
those with the metabolic syndrome than in those without (17.3
vs. 25.8 ng/ml, respectively)

29. B VITAMINS
•Vitamins B2, B3, B5 and B6 are particularly useful for controlling
weight
•Vitamin B2 helps to turn fat, sugar and protein into energy
•B3 is a component of the glucose tolerance factor (GTF), which is
released every time blood sugar rises, and vitamin B3 helps to keep
the levels in balance
•B6 is also important for maintaining hormone balance and, together
with B2 and B3, is necessary for normal thyroid hormone production
• So any deficiencies in these vitamins can affect thyroid function
and consequently affect the metabolism

30. CHROMIUM/CHROMIUM PICOLINATE
•It helps to encourage the formation of glucose tolerance factor (GTF) which is a
substance released by the liver and required to make insulin more efficient
•A deficiency of chromium can lead to insulin resistance, which is a key problem
in the case of PCOS; too much insulin can be circulating but it is unable to
control one’s blood sugar (glucose) levels
•Chromium is the most widely researched mineral used in the treatment of
overweight
•It helps to control cravings and reduces hunger, also helps to control fat and
cholesterol in the blood
•One study showed that people who took chromium over a ten-week period lost
an average of 1.9kg (4.2lb) of fat while those on a placebo (sugar tablet) lost only
0.2kg (0.4lb)
Warning:
A diabetic and on medication, one should speak to their doctor before taking
chromium

31. ZINC
•Important mineral for appetite control and a deficiency can cause a loss of taste and
smell, creating a need for stronger-tasting foods, including those that are saltier, sugary
and/or spicier (in other words, often more fattening!)
•Also necessary for the correct action of many hormones, including insulin
•Also functions together with vitamins A and E in the manufacture of thyroid hormone
MAGNESIUM
Magnesium levels have been found to be low in people with diabetes and there is a
strong link between magnesium deficiency and insulin resistance. It is, therefore, an
important mineral to include magnesium if suffering from PCOS
CO-ENZYME Q10
This vitamin-like substance, is important for energy production and normal
carbohydrate metabolism .
One study showed that people on a low-fat diet doubled their weight loss when they
supplemented with Co-Q10 as compared to those who did not take it. Co-Q10 has also
been proved useful in controlling blood sugar levels

32. HERBS : SAW PALMETTO
Saw palmetto works by inhibiting 5 alpha reductase, a
key enzyme in the breakdown of testosterone into
dihydrotestosterone (DHT) and hence can keep
androgen levels low
STINGING NETTLE
There is some evidence that Stinging nettle can help
reduce the conversion of testosterone into
dihydrotestosterone, a more potent form of the
hormone

33. GARCINIA CAMBOGIA
Garcinia cambogia is a small tropical fruit called the 'Malabar
tamarind’
It contains HCA (hydroxy-citric acid) which enables carbohydrates to
be turned into usable energy instead of being deposited as fat
The HCA in this fruit seems to curb appetite, reduce food intake and
inhibit the formation of fat and cholesterol
It seems to be particularly helpful when teamed with chromium
AGNUS CASTUS (VITEX/CHASTETREE
BERRY)
This is one of the most important herbs for PCOS because it helps to
stimulate and normalize the function of the pituitary gland, which
controls the release of LH (luteinizing hormone)

34. REFERENCES
1)www.nutritionandmetabolism.com
2)www.nutritionj.com
3)Introduction to Human Nutrition 2nd Edition Ed. Gibney,Lanham
New,Vorster
4)Gropper,Smith,Groff Advanced Nutrition and Human Metabolism 5th
Edition
5)International Journal of Obesity (2004) 28, 1026–1032.
doi:10.1038/sj.ijo.0802661 Published online 25 May 2004
6)Daya S: Luteal support: progestogens for pregnancy protection.
Maturitas 2009, 65 Suppl 1:S29-S34.
7)Alpert PT, Shaikh U: The effects of vitamin D deficiency and insufficiency on
the endocrine and paracrine systems.Biol Res Nurs 2007, 9(2):117-129.